Depressive symptoms predict medical care utilization in a population-based sample

Association between the mental domain of the comprehensive geriatric assessment and prolonged length of stay in hospitalized older adults with mild to moderate frailty

Introduction

Previous researches have shown the risk factors of prolonged length of stay (PLOS) in hospitalized older adults, but it is unclear what are the risk factors of PLOS in hospitalized older adults with mild to moderate frailty.

Objective

To identify the risk factors of PLOS in hospitalized older adults with mild to moderate frailty.

Methods

We recruited adults aged ≥65 years old with mild to moderate frailty admitted to a tertiary medical center in the southern Taiwan from June 2018 to September 2018. Each individual underwent a structural questionnaire interview within 72 h after admission and 72 h after discharge. The data were collected face-to-face, including demographic characteristics, comorbidities, length of stay (LOS), and multiple domains of the comprehensive geriatric assessment. The main outcome was PLOS.

Results

Individuals who had two or more drugs, were female, did not have cognitive impairment and had a Geriatric Depression Scale score ≥ 1 had a higher risk of PLOS (probability = 0.81), and these individuals accounted for 29% of the overall study population. Among male individuals younger than 87 years old, those with cognitive impairment had a higher risk of PLOS (probability = 0.76), and among male individuals without cognitive impairment, living alone was associated with a higher risk of PLOS (probability = 0.88).

Conclusion

Early detection and management of mood and cognition in older adults, together with comprehensive discharge planning and transition care, may be an important part of reducing LOS in hospitalized older adults with mild to moderate frailty.

Identification of psychiatric patients with high mortality and low medical utilization: a population-based propensity score-matched analysis

Background

The decreased life expectancy and care costs of mental disorders could be enormous. However, research that compares mortality and utilization concurrently across the major category of mental disorders is absent. This study investigated all-cause mortality and medical utilization among patients with and without mental disorders, with an emphasis on identifying the psychiatric category of high mortality and low medical utilization.

Methods

A total of 570,250 individuals identified from the 2002–2013 Taiwan National Health Insurance Reearch Database consistuted 285,125 psychiatric patients and 285,125 non-psychiatric peers through 1:1 dual propensity score matching (PSM). The expenditure survival ratio (ESR) was proposed to indicate potential utilization shortage. The category of mental disorders and 13 covariates were analyzed using the Cox proportional hazard model and general linear model (GLM) through SAS 9.4.

Results

PSM analyses indicated that mortality and total medical expenditures per capita were both significantly higher in psychiatric patients than those in non-psychiatric patients (all P <.0.0001). Patients with substance use disorders were reported having the youngest ages at diagnosis and at death, with the highest 25.64 of potential years of life loss (YPLL) and relevant 2904.89 of ESR. Adjusted Cox model and GLM results indicated that, compared with anxiety disorders, affective disorders and substance use disorders were significantly associated with higher mortality (HR = 1.246 and 1.064, respectively; all P < 0.05); schizophrenia was significantly associated with higher total medical expenditures per capita (P < 0.0001). Thirteen additional factors were significantly associated with mortality or utilization (all P < 0.05).

Conclusion

Substance use disorders are the category of highest YPLL but notably in insufficient utilization. Health care utilization in patients with substance use disorders should be augmented timely after the diagnosis, especially toward home and community care. The factors related to mortality and utilization identified by this study merit clinical attention.

Impact of the mental health and dynamic referral for oncology (MHADRO) program on oncology patient outcomes, health care utilization, and health provider behaviors: A multi-site randomized control trial

OBJECTIVE

The MHADRO assesses psychosocial and medical needs, provides tailored feedback reports, and connects patients to mental health providers. This study examined the MHADRO's effect on patient outcomes, health care utilization, and oncology provider documentation and behaviors.

METHODS

836 patients were part of a multi-site RCT and assessments were conducted at baseline, 2, 6 and 12 months.

RESULTS

The intervention group engaged in less emergency calls to providers. There were no differences in psychosocial outcomes at follow up assessments. Providers of patients in the intervention group were more likely to: document psychosocial symptoms and history; refer to psychosocial services; encourage support groups; seek psychological evaluations during visits. Patients who agreed to a mental health referral had decreased hospitalizations, increased mental health care interactions, and stronger ratings of counseling potential benefits. This group also reported increased psychosocial distress at all follow-up assessments.

CONCLUSION

The MHADRO may increase access to mental health care, lessen utilization, and improve providers' management of psychosocial needs, but does not appear to impact overall functioning over time.

PRACTICE IMPLICATIONS

Providers are encouraged to consider incorporating programs, like the MHADRO, into patient care as they may have the potential to impact screening and management of patients' psychosocial needs.

Depression and multimorbidity: Considering temporal characteristics of the associations between depression and multiple chronic diseases

OBJECTIVES

Depression frequently co-occurs with multiple chronic diseases in complex, costly, and dangerous patterns of multimorbidity. The field of health psychology may benefit from evaluating the temporal characteristics of depression's associations with common diseases, and from determining whether depression is a central connector in multimorbid disease clusters. The present review addresses these issues by focusing on 4 of the most prevalent diseases: hypertension, ischemic heart disease, arthritis, and diabetes.

METHOD

Study 1 assessed how prior chronic disease diagnoses were associated with current depression in a large, cross-sectional, population-based study. It assessed depression's centrality using network analysis accounting for disease prevalence. Study 2 presents a systematic scoping review evaluating the extent to which depression was prospectively associated with the onset of the 4 prevalent chronic diseases.

RESULTS

In Study 1 depression had the fourth highest betweenness centrality ranking of 26 network nodes and centrally connected many existing diseases and unhealthy behaviors. In Study 2 depression was associated with subsequent incidence of ischemic heart disease and diabetes across multiple meta-analyses. Insufficient information was available about depression's prospective associations with incident hypertension and arthritis.

CONCLUSIONS

Depression is central in patterns of multimorbidity and is associated with incident disease for several of the most common chronic diseases, justifying the focus on screening and treatment of depression in those at risk for developing chronic disease. Future research should investigate the mediating and moderating roles of health behaviors in the association between depression and the staggered emergence over time of clusters of multimorbid chronic diseases. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Hospitalisation and surgery: Is exposure associated with increased subsequent depressive symptoms? Evidence from The Irish Longitudinal Study on Ageing (TILDA)

BACKGROUND

The dramatic shift in the global population demographic has led to increasing numbers of older people undergoing hospitalisation and surgical procedures. While necessary, these exposures may lead to an increase in depressive symptoms.

OBJECTIVES

To determine whether hospitalisation or hospitalisation with surgery under general anaesthesia is associated with an increase in depressive symptoms in adults over the age of 50.

METHODS

Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale in 8036 individuals at waves 1 and 2 of The Irish Longitudinal Study on Ageing (TILDA), 2 years apart. Mixed-effects models were used to investigate the hypothesis after adjustment for risk factors for depression and potential confounders.

RESULTS

During the 12 months preceding wave 1, a total of 459 participants were hospitalised (mean age, 67.0; 55.3% female), and a further 548 participants (mean age, 64.6; 51.8% female) were hospitalised and underwent surgery with general anaesthesia; 6891 (mean age, 63.5; 54.3% female) were not hospitalised. Analysis of waves 1 and 2 data using mixed-effects models demonstrated that there was a 7% increased adjusted incidence rate of depressive symptoms (IRR [95% CI] = 1.07 [1.02-1.11]) in the Center for Epidemiologic Studies Depression Scale in the hospitalisation group and a 4% increased adjusted incidence rate of depressive symptoms (IRR [95% CI] = 1.04 [1.00-1.08]) in the surgery group compared with those with no hospitalisation.

CONCLUSION

Hospitalisation and hospitalisation with surgery and general anaesthesia are associated with increased depressive symptoms. This is the first time a longitudinal population-representative study has demonstrated this relationship for both exposures simultaneously.

Measurement properties of tools used to assess depression in adults with and without autism spectrum conditions: A systematic review

Depression is the most commonly experienced mental health condition in adults with autism spectrum conditions (ASC). However, it is unclear what tools are currently being used to assess depression in ASC, or whether tools need to be adapted for this group. This systematic review therefore aimed to identify tools used to assess depression in adults with and without ASC, and then evaluate these tools for their appropriateness and measurement properties. Medline, PsychINFO and Web of Knowledge were searched for studies of depression in: (a) adults with ASC, without co‐morbid intellectual disability; and (b) adults from the general population without co‐morbid conditions. Articles examining the measurement properties of these tools were then searched for using a methodological filter in PubMed, and the quality of the evidence was evaluated using the COSMIN checklist. Twelve articles were identified which utilized three tools to assess depression in adults with ASC, but only one article which assessed the measurement properties of one of these tools was identified and thus evaluated. Sixty‐four articles were identified which utilized five tools to assess depression in general population adults, and fourteen articles had assessed the measurement properties of these tools. Overall, two tools were found to be robust in their measurement properties in the general population—the Beck Depression Inventory (BDI‐II), and the patient health questionnaire (PHQ‐9). Crucially only one study was identified from the COSMIN search, which showed weak evidence in support of the measurement properties of the BDI‐II in an ASC sample. Implications for effective measurement of depression in ASC are discussed. Autism Res2018, 11: 738–754. © 2018 The Authors Autism Research published by International Society for Autism Research and Wiley Periodicals, Inc.

Lay Summary

Depression is the most common mental health problem experienced by adults with autism. However, the current study found very limited evidence regarding how useful tools developed for the general population are for adults with autism. We therefore suggest how these tools could be adapted to more effectively assess depression in adults with autism, and improve these individuals access to mental health assessment and support.

Healthcare burden of depression in adults with arthritis

INTRODUCTION

Arthritis and depression are two of the top disabling conditions. When arthritis and depression exist in the same individual, they can interact with each other negatively and pose a significant healthcare burden on the patients, their families, payers, healthcare systems, and society as a whole. Areas covered: The primary objective of this review is to summarize, identify knowledge gaps and discuss the challenges in estimating the healthcare burden of depression among individuals with arthritis. Electronic literature searches were performed on PubMed, Embase, EBSCOhost, Scopus, the Cochrane Library, and Google Scholar to identify relevant studies. Expert Commentary: Our review revealed that the prevalence of depression varied depending on the definition of depression, type of arthritis, tools and threshold points used to identify depression, and the country of residence. Depression exacerbated arthritis-related complications as well as pain and was associated with poor health-related quality of life, disability, mortality, and high financial burden. There were significant knowledge gaps in estimates of incident depression rates, depression attributable disability, and healthcare utilization, direct and indirect healthcare costs among individuals with arthritis.

The association between perceived unmet medical need and mental health among the Republic of Korea Armed Forces

INTRODUCTION

We investigated the effect of unmet medical need on the mental health of Republic of Korea (ROK) Armed Forces personnel, as most of the service members work in remote areas and often experience such unmet needs.

METHODS

This study used secondary data from the 2014 Military Health Survey (MHS), conducted by the ROK School of Military Medicine and designed to collect military health determinants. Descriptive statistics showed the general characteristics of the study populations by variable. We specifically compared the population after stratifying participants by suicide ideation. An analysis of variance was also carried out to compare Kessler Psychological Distress Scale 10 Scores. Additionally, dependent spouses and children of both active-duty service members and retirees are included among those entitled to Military Health System healthcare.

RESULTS

Among the 4967 military personnel, 681 (13.7%) individuals reported an experience of unmet medical need within the past 12 months and gave reasons of 'no time (5.15%)', 'long office wait (2.6%)', 'no money (0.22%)', 'long distance from base (1.19%)', 'illness but not very serious (1.65%)', 'mistrust in doctors (1.95%)' and 'pressure due to performance appraisal (0.95%)'. Regression analysis revealed that unmet medical need was significantly associated with negative mental health (β=1.753, p<0.0001) and increased suicide ideation (OR=2.649, 95% CI 1.84 to 3.82). Also, soldiers reporting unmet medical need due to 'no money', 'no time' or 'pressure due to performance appraisal' were significantly more likely to experience similar negative mental health effects.

CONCLUSIONS

Our study indicates that unmet medical need is significantly associated with soldiers' mental health decline and suicide ideation, highlighting the importance of providing military personnel with timely, affordable and sufficient medical care.

The Effect of Mental Distress on Women's Preventive Health Behaviors

Purpose.

To examine the relationship between mental distress and preventive health behaviors (i.e., mammograms, pap tests, physical exams) among women.

Methods.

A cross-sectional design was employed. The sample consisted of 426 women from the Appalachian region in the United States who completed a comprehensive health survey. Mental distress was assessed by the 5-item Mental Health Index (MHI). Logistic regression was used to specify the models allowing for the control of covariates (i.e., marital status, education, recipient of Medicaid).

Results.

Women who reported high mental distress were more likely to not get timely pap tests [OR = 1.64; 95% CI (1.10, 2.45); p < .05] or physical exams [OR = 1.68; 95% CI (1.07, 2.65); p < .05] than women who did not report being mentally distressed. A similar but less robust relationship was found between mental distress and timely mammograms.

Conclusions.

These findings suggest that mental distress affects the likelihood of engagement in preventive health behaviors.

A Longitudinal Analysis of Discrete Negative Emotions and Health-Services Use in Elderly Individuals

Objective: To test the hypothesis that everyday, discrete negative emotions—anger, frustration, sadness, and fear—relate to health-service use in later life. Method: Community-dwelling adults ( n= 345) ages 72 to 99 were interviewed about the frequency of recently experienced emotions. Physician visits and hospital admissions in the subsequent 2 years were outcomes. Covariates included prior use of health services, chronic illness, functional status, and demographics. Results: Age, education, and gender moderated relations between negative emotions and health care use. More frustration was associated with fewer physician visits among older individuals. Sadness was associated with more hospital admissions for women. Among those with more education, frequent anger was associated with more physician visits. Projected effects of negative emotions resulted in increases in health-service use, ranging from 18% to 33%. Discussion: The interactions indicate the importance of negative emotions and the larger social and developmental context in health care services use among elderly individuals.

Satisfaction With General Practitioner Treatment of Depression Among Residents of Aged Care Facilities

Objective: This article investigates consumer perspectives on the treatment for depression among older people in residential facilities. Method: Aged care residents who were aware of being treated for depression in the past 6 months (24 women and 7 men, mean age = 83 years) participated in an interview that assessed their perspective on treatments. Results: Although more than half of the participants in the sample reported overall satisfaction with the medical treatments received for depression, qualitative data provided indications of unsatisfactory service delivery, including perceptions of low treatment efficacy, short consultation times, the failure to assess affective symptomatology, and negative responses to residents’ disclosure of symptoms. Discussion: The findings are discussed in relation to previous research on consumer satisfaction with health services and issues that may be pertinent to the elderly depressed. Training for general practitioners providing treatment in aged care is indicated.

Health-related social control among older men with depressive symptomatology

OBJECTIVES

Social control attempts, or attempts by social network members to influence a person's behavior, significantly predict men's health behaviors and psychological well-being. Despite the fact that depression is associated with compromised interpersonal functioning and poor health behaviors, the association between social control processes and depression has not been studied. Thus, this pilot study explored differential vulnerability to spouses' social control attempts among older, male primary care patients with varying levels of depression symptom severity and the degree to which these attempts predicted patients' behavioral and affective responses.

METHOD

Participants included 88 older men referred by their primary care providers for a behavioral health assessment at a Veterans Affairs Medical Center. Data on sociodemographics, depressive symptomatology, health behaviors, spouses' positive and negative social control attempts, and patients' behavioral and affective responses to attempts were collected by telephone.

RESULTS

The sample was primarily Caucasian (mean age = 65.3 (SD = 8.1) years). Patients' higher depressive symptoms were significantly associated with positive and negative affective responses to their spouses' social control attempts. The frequency of control attempts and patients' behavioral responses, however, were unrelated to patients' depressive symptoms. Multiple regression models revealed that while spouses' control attempts were unrelated to patients' positive behavioral responses, more frequent negative attempts predicted greater negative behavioral responses (e.g., ignoring spouses' attempts). Moreover, negative control attempts predicted greater negative affective responses (e.g., resentment, sadness).

CONCLUSION

The findings highlight the value of identifying effective social control strategies that maximize positive behavioral change, emotional responses, and health outcomes among older men with depressive symptoms.

Voice problems and depression among adults in the United States

OBJECTIVES/HYPOTHESIS

Prior studies have observed a high prevalence of psychosocial distress, including depression, in patients with voice problems. However, these studies have largely been performed in care-seeking patients identified in tertiary care voice clinics. The objective of this study was to examine the association between depression and voice problems in the U.S.

STUDY DESIGN

Cross-sectional analysis of National Health Interview Survey (NHIS) data.

METHODS

We identified adult cases reporting a voice problem in the preceding 12 months in the 2012 NHIS. Self-reported demographics and data regarding healthcare visits for voice problems, diagnoses given, severity of the voice problem, and depression symptoms were analyzed.

RESULTS

The total weighted sample size was 52,816,364. The presence of depressive symptoms was associated with a nearly two-fold increase (odds ratio = 1.89, 95% confidence interval = 1.21-2.96) in the likelihood of reporting a voice problem in the past year. Patients who reported feeling depressed were less likely to receive care for the voice problem and less likely to report that treatment had helped than those who did not feel depressed.

CONCLUSION

These findings indicate that the co-occurrence of voice problems and depressive symptoms is observed in the general population, not only in care-seeking patients, and that depressive symptoms may influence reported likelihood of receiving voice treatment and effectiveness. This suggests that voice care providers should take mental health symptoms into account when treating patients, and also indicates a need for further investigation.

LEVEL OF EVIDENCE

NA. Laryngoscope, 126:1859-1864, 2016.

Patient-reported geriatric symptoms as risk factors for hospitalization and emergency department visits

There is an urgent need to identify predictors of adverse outcomes and increased health care utilization in the elderly. The Mayo Ambulatory Geriatric Evaluation (MAGE) is a symptom questionnaire that was completed by patients aged 65 years and older during office visits to Primary Care Internal Medicine at Mayo Clinic in Rochester, MN. It was introduced to improve screening for geriatric conditions. We conducted this study to explore the relationship between self-reported geriatric symptoms and hospitalization and emergency department (ED) visits within 1 year of completing the survey. This was a retrospective cohort study of patients who completed the MAGE from April 2008 to December 2010. The primary outcome was an ED visit or hospitalization within 1 year. Predictors included responses to individual questions in the MAGE. Data were obtained from the electronic medical record and administrative records. Logistic regression analyses were performed from significant univariate factors to determine predictors in a multivariable setting. A weighted scoring system was created based upon the odds ratios derived from a bootstrap process. The sensitivity, specificity, and AUC were calculated using this scoring system. The MAGE survey was completed by 7738 patients. The average age was 76.2 ± 7.68 years and 57% were women. Advanced age, a self-report of worse health, history of 2 or more falls, weight loss, and depressed mood were significantly associated with hospitalization or ED visits within 1 year. A score equal to or greater than 2 had a sensitivity of 0.74 and specificity of 0.45. The calculated AUC was 0.60. The MAGE questionnaire, which was completed by patients at an outpatient visit to screen for common geriatric issues, could also be used to assess risk for ED visits and hospitalization within 1 year.

The association between depressive symptoms in the community, non-psychiatric hospital admission and hospital outcomes: a systematic review

OBJECTIVES

This paper aims to systematically review observational studies that have analysed whether depressive symptoms in the community are associated with higher general hospital admissions, longer hospital stays and increased risk of re-admission.

METHODS

We identified prospective studies that looked at depressive symptoms in the community as a risk factor for non-psychiatric general hospital admissions, length of stay or risk of re-admission. The search was carried out on MEDLINE, PsycINFO, Cochrane Library Database, and followed up with contact with authors and scanning of reference lists.

RESULTS

Eleven studies fulfilled our inclusion and exclusion criteria, and all were deemed to be of moderate to high quality. Meta-analysis of seven studies with relevant data suggested that depressive symptoms may be a predictor of subsequent admission to a general hospital in unadjusted analyses (RR=1.36, 95% CI: 1.28-1.44), but findings after adjustment for confounding variables were inconsistent. The narrative synthesis also reported depressive symptoms to be independently associated with longer length of stay, and higher re-admission risk.

CONCLUSIONS

Depressive symptoms are associated with a higher risk of hospitalisation, longer length of stay and a higher re-admission risk. Some of these associations may be mediated by other factors, and should be explored in more details.

Health care avoidance among people with serious psychological distress: analyses of 2007 Health Information National Trends Survey

Using data of 2007 Health Information National Trends Survey, we investigated the association between individuals' psychological distress and their reported avoidance of medical care and assessed whether people with serious psychological distress (SPD) were more likely to report psychosocial barriers to care. After controlling for demographic and health characteristics, individuals with SPD were more likely than those without SPD to report having avoided visiting a doctor even when they suspected they should (OR=1.64, 95% CI=1.08-2.48). The distressed individuals were also more likely to agree that they avoided a doctor because of fear of having a serious illness (OR=1.99, 95% CI=1.15-3.44) or thinking about dying (OR=2.15, 95% CI=1.12-4.11). Further understanding of the mechanism under which an individuals' mental health status may influence their perceived need for health and their use of medical services would improve the interface between mental health and primary care services.

Hospital costs associated with depression in a cohort of older men living in Western Australia

BACKGROUND

There is lack of information of the hospital costs related to depression. Here, we compare the costs associated with general hospital admissions over 2 years between older men with and without a documented past history of depression.

METHODS

A community-based cohort of older men living in Perth, Western Australia, was assessed at baseline between 2001 and 2004 and followed up for 2 years by prospective data linkage. The participants were selected randomly from the Australia electoral roll. Two-year hospital costs were estimated.

RESULTS

Among 5411 patients, 75% of 339 men with depressive symptoms had at least one hospital admission compared with 61% of 5072 men without depression (P<.001). Two-year median hospital costs in the depressed group were A$4153 compared with A$1671 in participants free from depression (P<.001). In multivariate analysis, the presence of clinically significant depressive symptoms remained an independent predictor of higher cost [incident rate ratios (RR)=1.44, 95% confidence interval (CI): 1.23-1.68] and was associated with being a high-cost user of health services (RR=2.04, 95% CI: 1.43-2.92).

LIMITATIONS

The estimation of costs was solely based on the main diagnosis, potentially leading to underestimates of the real cost differences.

CONCLUSIONS

Hospital care cost was higher for older men with documented evidence of past depression than those without. The issue of depression in later life must be tackled if we want to optimize the use of limited hospital resources available.

Recent medical service utilization and health conditions associated with a history of suicide attempts

OBJECTIVES

Suicide is a leading cause of death; unfortunately most individuals at risk for suicide are not identified, assessed or treated by the mental health system. Investigating medical healthcare utilization among individuals with a history of suicide attempt may identify alternative settings for case finding and brief intervention.

METHODS

The study sample (n=1422, 58% female, 72% African-American) is from a prospective cohort of adults (27-31 years) who participated in a randomized trial of school-based interventions. Logistic regression evaluated the relationship between lifetime history of suicide attempt with past year medical service utilization and selected self- reported health conditions, controlling for lifetime Major Depressive Disorder (MDD), demographic factors, health insurance status and employment.

RESULTS

A suicide attempt history was associated with past year emergency department medical visits [aOR 1.51, 95% CI 1.04-2.18, P=.03], but not primary care visits or inpatient hospitalization, when controlling for MDD and other covariates. Severe headaches and chronic gastrointestinal conditions were also associated with lifetime suicide attempt [aOR 1.50, 95% CI 1.03-2.17 and aOR 1.67, 95% CI 1.06-2.63, respectively].

CONCLUSIONS

Suicide prevention, including universal screening and brief intervention, is indicated in emergency department settings. Restricting screening to subgroups, such as those individuals presenting with depression, may miss at-risk individuals with somatic concerns.

Prevalence and correlates of depression among HIV-infected and -affected older people in rural South Africa

BACKGROUND

Little is known about depression in older people in sub-Saharan Africa, the associated impact of HIV, and the influence on health perceptions.

OBJECTIVES

Examine the prevalence and correlates of depression; explore the relationship between depression and health perceptions in HIV-infected and -affected older people.

METHODS

In 2010, 422 HIV-infected and -affected participants aged 50+ were recruited into a cross-sectional study. Nurse professionals interviewed participants and a diagnosis of depressive episode was derived from the Composite International Diagnostic Interview (Depression module) using the International Classification of Diseases diagnostic criteria and categorised as major (MDE) or brief (BDE).

RESULTS

Overall, 42.4% (n=179) had a depressive episode (MDE: 22.7%, n=96; BDE: 19.7%, n=83). Prevalence of MDE was significantly higher in HIV-affected (30.1%, 95% CI 24.0-36.2%) than HIV-infected (14.8%, 95% CI 9.9-19.7%) participants; BDE was higher in HIV-infected (24.6%, 95% CI 18.7-30.6%) than in HIV-affected (15.1%, 95% CI 10.3-19.8%) participants. Being female (aOR 3.04, 95% CI 1.73-5.36), receiving a government grant (aOR 0.34, 95% CI 0.15-0.75), urban residency (aOR 1.86, 95% CI 1.16-2.96) and adult care-giving (aOR 2.37, 95% CI 1.37-4.12) were significantly associated with any depressive episode. Participants with a depressive episode were 2-3 times more likely to report poor health perceptions.

LIMITATIONS

Study limitations include the cross-sectional design, limited sample size and possible selection biases.

CONCLUSIONS

Prevalence of depressive episodes was high. Major depressive episodes were higher in HIV-affected than HIV-infected participants. Psycho-social support similar to that of HIV treatment programmes around HIV-affected older people may be useful in reducing their vulnerability to depression.

Help-seeking for emotional problems in major depression : findings of the 2006 Estonian health survey

To study help-seeking among the general population and people with major depression. 12-month help-seeking for emotional problems was assessed in a cross-sectional 2006 Estonian Health Survey. Non-institutionalized individuals aged 18-84 years (n = 6,105) were interviewed. A major depressive episode was assessed using the Mini-International Neuropsychiatric Interview. The factors associated with help-seeking, received help, and health service use were analyzed. The prevalence of 12-month help-seeking for emotional symptoms was 4.8%. The rate of 12-month help-seeking in the depressed sample was 34.1%. Depressed people used non-mental health services 1.5-3 times more than non-depressed persons even when adjusted for the chronic somatic disorder. Only one third of depressed persons sought help, which was most of all associated with severity of depression. Underdiagnosis and undertreatment of depression leads to an increased use of expensive but non-specific health services by depressed persons.

Co-occurring depression and pain in multiple sclerosis

Depression and pain are highly prevalent among individuals with multiple sclerosis, and they often co-occur. The purpose of this article is to summarize the literature and theory related to the comorbidity of pain and depression and describe how their presence can impact individuals with multiple sclerosis. Additionally, the article discusses how existing treatments of pain and depression could be adapted to address shared mechanisms and overcome barriers to treatment utilization.

The excess healthcare costs associated with depression and anxiety in elderly living in the community

OBJECTIVE

To estimate the excess healthcare costs attributable to depression and anxiety in a public managed care system.

METHODS

The data were retained from a population-based health survey on 2,494 community-dwelling older adults age 65 years or more participating in the ESA (Étude sur la Santé des Aînés) study. Depression and anxiety were assessed using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria and measured at two time points 1 year apart. Annual healthcare costs considered included hospitalizations, emergency and outpatient visits, physician fees, and outpatient medications. Health service use and costs were identified from provincial administrative databases. Costs were studied as a function of the presence (yes/no) of depression and anxiety, and as persistence, incidence/remission, and no illness. Generalized linear models with a gamma distribution (log link) were used to control for a number of factors.

RESULTS

Participants with depression had higher outpatient mental health-related costs. Participants with anxiety had higher total healthcare costs and specifically outpatient costs and inpatient costs. As opposed to people without depression and anxiety, persistent cases had higher mean costs followed by people with the disorders for only part of the year. Most of these differences were explained by sociodemographic and clinical factors. The excess annual adjusted healthcare costs of depression, anxiety, and comorbid depression and anxiety reached $27.4, $80.0, and $119.8 million per 1,000,000 population of elderly, respectively.

CONCLUSION

The excess costs of depression and anxiety in community-dwelling elderly are just as significant as those observed for adults even when productivity losses are not considered. Adequately managing depression and anxiety in the older adult population may lead to important healthcare cost savings for society.

The costs associated with antidepressant use in depression and anxiety in community-living older adults

OBJECTIVE

To determine the costs associated with antidepressant (AD) use by depression and anxiety status in a public-managed health care system.

METHODS

Data were obtained from a population-based health survey of 1869 older adults. Depression and anxiety were based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and measured at 2 time points 1 year apart. AD and health service use and costs were identified from provincial administrative databases and included hospitalizations, physician fees, outpatient medications, and ambulatory visits. Patient costs considered were related to drug copayments, transportation, and time spent seeking medical care. Annual costs associated with AD use were studied as a function of mental health status at baseline and follow-up interviews (persistence, incidence, remission, or no illness). Generalized linear models with a gamma distribution were used to control for individual factors.

RESULTS

The costs incurred by participants using ADs as a whole (17.8%) reached $6678 (95% CI $5449 to $8182), significantly more than in participants not using ADs ($4698; 95% CI $3710 to $5949). AD use was associated with greater total adjusted costs among respondents with no depression (adjusted difference = $1769; 95% CI $236 to $3702) and no anxiety (adjusted difference = $1845; 95% CI $203 to $3486).

CONCLUSION

The results showed that AD use was not associated with cost savings in any group, and indeed with greater costs among participants who were neither depressed nor anxious at any time point. Future cost studies may consider the analyses of different AD classes regarding the different clinical mental health profiles in older adults.

The association of depression with pain-related treatment utilization in patients with multiple sclerosis

OBJECTIVE

To better understand the association of depression with pain treatment utilization in a multiple sclerosis (MS) population.

DESIGN

Cross-sectional survey.

SETTING

Community-based survey.

PARTICIPANTS

Convenience sample of 117 individuals with MS.

MAIN OUTCOME MEASURES

Participants provided demographic information, descriptive information on utilization of pain treatments, pain intensity ratings on a 0-10 numerical rating scale, and depressive symptoms on the Patient Health Questionnaire-9 (PHQ-9).

RESULTS

Participants reporting clinical levels of depressive symptoms (PHQ-9 ≥10) reported that they tried more pain treatments previously relative to participants with PHQ-9 <10; however, the two groups did not differ in the number of treatments they were currently using. Additionally, participants with PHQ-9 ≥10 had more visits to providers for pain treatment relative to the group with PHQ-9 <10. In subsequent analyses, results showed that these differences were no longer significant after controlling for level of pain intensity.

CONCLUSIONS

The results demonstrate that depression is not associated with higher pain treatment utilization. These findings support the assertion in previous studies that the mechanism by which depression impacts medical utilization is through increased appointments for nonspecific complaints, not for specific medical problems. While this suggests that treating depression may not be helpful in reducing pain treatment utilization specifically, it remains important to treat depression to reduce pain-related suffering and medical utilization more broadly.

Depressive symptoms are not associated with leukocyte telomere length: findings from the Nova Scotia Health Survey (NSHS95), a population-based study

Background

Premature shortening of leukocyte telomere length has been proposed as a novel mechanism by which depression may confer increased risk of adverse cardiovascular events. Prior studies demonstrating associations of depression and depressive symptoms with shorter leukocyte telomere length were small, included selected psychiatric outpatients, were based on convenience samples, and/or adjusted for a limited number of possible confounding factors.

Methods and Findings

We examined the associations of depressive symptoms, probable depressive disorder, and specific depressive symptom clusters, as assessed by the Center for Epidemiological Studies—Depression (CES-D) scale, with leukocyte telomere length, measured by using a real-time PCR method, in 2,225 apparently healthy participants from the 1995 Nova Scotia Health Survey population-based study. The mean age was 48.2±18.9 years; 49.9% of participants were female; and the mean CES-D score was 7.4±7.9. The mean telomere length was 5,301±587 base pairs. In an unadjusted model, depressive symptoms were significantly associated with longer leukocyte telomere length (B = 27.6 base pairs per standard deviation increase in CES-D, 95% confidence interval [CI] = 3.1–52.1, p = 0.027). This association was no longer significant after adjustment for age and sex (B = 9.5, 95% CI = −14.6–33.6, p = 0.44) or after further adjustment for body mass index, Framingham risk score and previous history of ischemic heart disease (all p's≥0.37). Neither probable depressive disorder nor specific depressive symptom clusters were independently associated with leukocyte telomere length.

Conclusions

Concurrent depressive symptoms were not associated with leukocyte telomere length in a large, representative, population-based study.

Cancer screening of long-term cancer survivors

BACKGROUND

Although 64% of cancer survivors are expected to live at least 5 years beyond diagnosis, the receipt of cancer screening by this population is unclear. The objective of this study was to assess the relation between a cancer diagnosis and future cancer screening, exploring provider-, patient-, and cancer-specific factors that explain observed relationships.

METHODS

The Wisconsin Longitudinal Study (WLS) and Wisconsin Tumor Registry were used to identify 2 participant groups: 415 patients diagnosed with nonmetastatic cancer between 1992 to 1993 (before cancer) and 2003 to 2004 (after cancer) and 4680 controls (no cancer). Adjusted average predicted probabilities of cancer screening were estimated with models that first did not include and then included, provider (provider relationship length), participant (depressive symptoms per the Center for Epidemiologic Studies Depression Scale), and cancer-specific (time since diagnosis) factors. Participants with a history of cancer associated with a given screening test were then excluded to assess whether relationships are explained by screening for recurrence versus second cancers.

RESULTS

Female cancer survivors were more likely than no-cancer controls to undergo pelvic/Papanicolaou screening (survivors: 70%, 95% confidence interval [CI]: 63% to 76%; controls: 61%, 95% CI: 59% to 63%) and mammography screening (survivors: 86%, 95% CI: 78% to 90%; controls: 76%, 95% CI: 74% to 77%), though male cancer survivors were not more likely to receive prostate exams (survivors: 76%, 95% CI: 70% to 82%; controls: 69%, 95% CI: 67% to 71%). After excluding people with a history of the cancer being screened for, there were few significant differences in cancer screening between short- or long-term survivors (≥5 years) and no-cancer controls. Relationships were not sensitive to adjustment for provider or participant factors.

CONCLUSIONS

The significant positive differences in cancer screening between people with and without cancer can be explained by screening for recurrence. Long-term cancer survivors are not more likely to receive follow-up screening for second cancers. This information should be used by providers to ensure patients receive recommended follow-up preventive care.

Blood Pressure Reactivity to an Anger Provocation Interview Does Not Predict Incident Cardiovascular Disease Events: The Canadian Nova Scotia Health Survey (NSHS95) Prospective Population Study

We examined the association between blood pressure (BP) reactivity to an anger provocation interview and 10-year incident CVD events in 1,470 adults from the population-based 1995 Nova Scotia Health Survey (NSHS95). In an unadjusted model, those in the highest decile of systolic BP reactivity were more than twice as likely to have an incident CVD event compared to those in the decile with no reactivity (HR = 2.33, 95% CI = 1.15 - 4.69, P = 0.02). However, after adjusting for age and sex, and then also for Framingham risk score, body mass index, and education, this relationship was attenuated and not statistically significant. Diastolic BP reactivity was not associated with CVD incidence in any model. Individual differences in BP reactivity to a laboratory-induced, structured anger provocation interview may not play a major role in clinical CVD endpoints.

Observed hostility and the risk of incident ischemic heart disease: a prospective population study from the 1995 Canadian Nova Scotia Health Survey

OBJECTIVES

The aim of this study was to examine the relation between hostility and incident ischemic heart disease (IHD) and to determine whether observed hostility is superior to patient-reported hostility for the prediction of IHD in a large, prospective observational study.

BACKGROUND

Some studies have found that hostile patients have an increased risk of incident IHD. However, no studies have compared methods of hostility assessment or considered important psychosocial and cardiovascular risk factors as confounders. Furthermore, it is unknown whether all expressions of hostility carry equal risk or whether certain manifestations are more cardiotoxic.

METHODS

We assessed the independent relationship between baseline observed hostility and 10-year incident IHD in 1,749 adults of the population-based Canadian Nova Scotia Health Survey.

RESULTS

There were 149 (8.5%) incident IHD events (140 nonfatal, 9 fatal) during the 15,295 person-years of observation (9.74 events/1,000 person-years). Participants with any observed hostility had a greater risk of incident IHD than those without (p = 0.02); no such relation was found for patient-reported hostility. Those with any observed hostility had a significantly greater risk of incident IHD (hazard ratio: 2.06, 95% confidence interval: 1.04 to 4.08, p = 0.04), after adjusting for cardiovascular (age, sex, Framingham Risk Score) and psychosocial (depression, positive affect, patient-reported hostility, and anger) risk factors.

CONCLUSIONS

The presence of any observed hostility at baseline was associated with a 2-fold increased risk of incident IHD over 10 years of follow-up. Compared with patient-reported measures, observed hostility is a superior predictor of IHD.

Depression and HIV in Botswana: a population-based study on gender-specific socioeconomic and behavioral correlates

Background

Depression is a leading contributor to the burden of disease worldwide, a critical barrier to HIV prevention and a common serious HIV co-morbidity. However, depression screening and treatment are limited in sub-Saharan Africa, and there are few population-level studies examining the prevalence and gender-specific factors associated with depression.

Methods

We conducted a cross-sectional population-based study of 18–49 year-old adults from five districts in Botswana with the highest prevalence of HIV-infection. We examined the prevalence of depressive symptoms, using a Hopkins Symptom Checklist for Depression (HSCL-D) score of ≥1.75 to define depression, and correlates of depression using multivariate logistic regression stratified by sex.

Results

Of 1,268 participants surveyed, 25.3% of women and 31.4% of men had depression. Among women, lower education (adjusted odds ratio [AOR] 2.07, 95% confidence interval [1.30–3.32]), higher income (1.77 [1.09–2.86]), and lack of control in sexual decision-making (2.35 [1.46–3.81]) were positively associated with depression. Among men, being single (1.95 [1.02–3.74]), living in a rural area (1.63 [1.02–2.65]), having frequent visits to a health provider (3.29 [1.88–5.74]), anticipated HIV stigma (fearing discrimination if HIV status was revealed) (2.04 [1.27–3.29]), and intergenerational sex (2.28 [1.17–4.41]) were independently associated with depression.

Discussion

Depression is highly prevalent in Botswana, and its correlates are gender-specific. Our findings suggest multiple targets for screening and prevention of depression and highlight the need to integrate mental health counseling and treatment into primary health care to decrease morbidity and improve HIV management efforts.

Depression, nutritional risk and eating behaviour in older caregivers

OBJECTIVE

This study investigated the relationship between depression, nutritional risk and dietary intake in a population of older caregivers.

DESIGN

Mailed questionnaire with sub group participating in a home-based interview.

PARTICIPANTS AND SETTING

Seventy-six community dwelling caregivers aged 50 y or over from Victoria, Australia.

MEASUREMENTS

Questionnaires provided information on weight, height, hours of care, depressive symptoms, nutritional risk and appetite. The home-based interview assessed dietary intake and shopping, cooking and meal consumption habits.

RESULTS

The sample had a mean +/- SD age of 70.3 +/- 12.8 y, BMI of 27.2 +/- 4.8 kg/m2 and the time spent caring was 101.8 +/- 68.1 h/wk. Overall, 32% of caregivers had depressive symptoms, 21% were at risk of malnutrition and 21% reported their appetite was fair/bad/very bad. Caregivers with depressive symptoms (32%) compared to those with no depressive symptoms (53%) had a poorer appetite (p < 0.05). Of the 20 caregivers who participated in the home interview, 25% reported they ate their meals alone.

CONCLUSION

A significant proportion of community dwelling older caregivers had depressive symptoms, were at risk of malnutrition and had poor appetites, although the majority were overweight or obese.

Healthy IDEAS: implementation of a depression program through community-based case management

PURPOSE

Healthy IDEAS (HIDEAS; IDEAS stands for Identifying Depression, Empowering Activities for Seniors) is an evidence-based depression program addressing commonly recognized barriers to mental health care for older adults. The purpose of this study was to describe the implementation of HIDEAS and assess its feasibility.

DESIGN AND METHODS

Three community agencies implemented the program with 94 eligible older adults who were identified from 348 screened older adults. We assessed program implementation by using the Core Implementation Component framework, using a client-tracking database, written survey of case managers, focus-group interview with coaches, and agency and project progress reports.

RESULTS

We identified several challenges: clients' reluctance to acknowledge depressive symptoms and difficulty in engaging in behavioral changes; differences among case managers' mental health knowledge, skills, and "buy-in" and difficulty managing limited time; and differences in agency culture that foster in-agency supervision.

IMPLICATIONS

Successful adoption and sustainability of HIDEAS are more likely when essential elements of the Core Implementation Component framework are addressed to bring about behavioral changes at all treatment-implementation levels-clients, practitioners, and organizations.

Depressive symptoms among older adults in Mexico City

BACKGROUND

Ageing and depression are associated with disability and have significant consequences for health systems in many other developing countries. Depression prevalence figures among the elderly are scarce in developing countries.

OBJECTIVE

To estimate the prevalence of depressive symptoms and their cross-sectional association with selected covariates in a community sample of Mexico City older adults affiliated to the main healthcare provider.

DESIGN

Cross-sectional, multistage community survey.

PARTICIPANTS

A total of 7,449 persons aged 60 years and older.

MEASUREMENTS

Depression was assessed using the 30-item Geriatric Depression Scale (GDS); cognitive impairment, using the Mini-Mental State Examination; and health-related quality of life with the SF-36 questionnaire.

MAIN RESULTS

The prevalence of significant depressive symptoms was estimated to be 21.7%, and 25.3% in those aged 80 and older. After correcting for GDS sensitivity and specificity, major depression prevalence was estimated at 13.2%. Comparisons that follow are adjusted for age, sex, education and stressful life events. The prevalence of cognitive impairment was estimated to be 18.9% in depressed elderly and 13.7% in non-depressed. SF-36 overall scores were 48.0 in depressed participants and 68.2 in non-depressed (adjusted mean difference = -20.2, 95% CI = -21.3, -19.1). Compared to non-depressed elderly, the odds of healthcare utilization were higher among those depressed, both for any health problem (aOR 1.4, 95% CI = 1.1, 1.7) and for emotional problems (aOR 2.7, 95% CI = 2.2, 3.2).

CONCLUSIONS

According to GDS estimates, one of every eight Mexican older adults had major depressive symptoms. Detection and management of older patients with depression should be a high priority in developing countries.

Chronic disease risk factors associated with health service use in the elderly

Background

To examine the association between number and combination of chronic disease risk factors on health service use.

Methods

Data from the 1995 Nova Scotia Health Survey (n = 2,653) was linked to provincial health services administrative databases. Multivariate regression models were developed that included important interactions between risk factors and were stratified by sex and at age 50. Negative-binomial regression models were estimated using generalized estimating equations assuming an autoregressive covariance structure.

Results

As the number of chronic disease risk factors increased so did the number of annual general practitioner visits, specialist visits and days spent in hospital in people aged 50 and older. This was not seen among individuals under age 50. Comparison of smokers, people with high blood pressure and people with high cholesterol showed no significantly different impact on health service use.

Conclusion

As the number of chronic disease risk factors increased so did health service use among individuals over age 50 but risk factor combination had no impact.

Follow-up study on health care use of patients with somatoform, anxiety and depressive disorders in primary care

Background

Better management of affective and somatoform disorders may reduce consultation rates in primary care. Somatoform disorders are highly prevalent in primary care and co-morbidity with affective disorders is substantial, but it is as yet unclear which portion of the health care use may be ascribed to each disorder. Our objective was to investigate the use of primary care for undifferentiated somatoform disorders, other somatoform disorders, anxiety and depressive disorders prospectively.

Methods

In eight family practices 1046 consulting patients (25–79 yrs) were screened and a stratified sample of 473 was interviewed. Somatoform disorders, anxiety and depressive disorders were diagnosed (DSM IV) using SCAN 2.1. The electronic records of 400 participants regarding somatic diseases, medication and healthcare use were available through their family physicians (FP).

Results

In the follow-up year patients with psychiatric disorders had more face-to-face contacts with the FP than patients who had no psychiatric disorder: average 7–10 versus 5. The impact on the use of primary care by patients with somatoform disorders was comparable to patients with depressive or anxiety disorders. Undifferentiated somatoform disorders had an independent impact on the use of primary care after adjustment for anxiety and depressive disorders, resulting in 30% more consultations (IRR 1.3 (95% CI: 1.1–1.7)). Anxiety disorders had no independent effect.

Conclusion

Health care planning should focus on the recognition and treatment of somatoform as well as affective disorders.

Healthcare and preventive services utilization of elderly Europeans with depressive symptoms

BACKGROUND

Depressive symptoms are associated with increased healthcare utilization. However, it is unclear whether depressed individuals experience more or less frequent access to preventive services. Our goal was to investigate the association between depressive symptoms and both utilization of healthcare and preventive services.

METHODS

Baseline self-reported data (2004) from non-institutionalized individuals aged > or =50 years participating in the Survey of Health, Ageing, and Retirement in Europe (SHARE) were used. Of the 18,560 respondents to the baseline questionnaire, 13,580 answered the supplementary questionnaire, which included measures of preventive services. Healthcare utilization during the previous 12 months, including outpatient visits, medication, hospitalization, surgery, and home healthcare were assessed. Preventive service measures assessed the participation in influenza immunization and colorectal and breast cancer screening. Depression status was assessed with the EURO-D, a validated instrument for which a score >3 defines clinically significant depressive symptoms. Logistic regressions were performed adjusting for age, gender, socioeconomic status, behavioral risk, chronic disease, disability, and country of residence.

RESULTS

The estimated prevalence of depressive symptoms was 28.2%. Depressive symptoms were associated with significantly greater use of all healthcare domains but not preventive services, with the exception of colorectal cancer screening. Similar trends were found for each country of residence and for both genders.

LIMITATIONS

It was not known whether medical tests were used for screening or diagnostic purposes.

CONCLUSIONS

SHARE data suggest that patients with depressive symptoms are frequent users of healthcare but not preventive services. Low screening rates may reflect missed screening opportunities rather than a lack of screening opportunities.

Psychosocial and health consequences of adolescent depression in Black and White young adult women

Depression in adolescent girls may result in negative consequences in young adulthood. The Center for Epidemiologic Studies Depression Scale (CES-D) was administered to 1,727 Black and White girls ages 16 to 18 years who participated in the National Heart, Lung, and Blood Institute's Growth and Health Study. Three years later, women in the depressed groups were more likely to be current smokers, had attained a lower level of education, and reported lower self-worth relative to the nondepressed group. Body dissatisfaction, eating concerns, and loneliness were greater in the depressed groups. Relative to Black women, White women who were moderately depressed during adolescence reported more health care services utilization in young adulthood. Prevention efforts for depressed adolescents should be broadly focused to improve young adult outcomes.

Psychological Distress as a Barrier to Preventive Care in Community-Dwelling Elderly in the United States

OBJECTIVE

The presence of psychologic distress in older adults may be associated with decreased adherence to recommended preventive-care services. This analysis aimed to measure the association between psychologic distress and adherence to United States Preventive Services Task Force (USPSTF)-recommended preventive-care services among older adults in the United States.

DESIGN

We undertook a cross-sectional analysis of 3655 U.S. community-dwelling elderly from the 2001 Medical Expenditure Panel (MEPS) survey.

MEASUREMENTS

The presence of psychologic distress was captured by the Mental Component Survey (MCS) of the SF-12. The receipt of 9 preventive care services were captured using MEPS: hypertension screening, influenza vaccination, fecal occult blood testing or sigmoidoscopy, mammography, clinical breast examination, cholesterol screening, prostate-specific antigen test, routine check-up, and dental checkup.

RESULTS

Elderly reporting psychologic distress were 30% less likely than nondistressed elderly to receive influenza vaccination (OR = 0.70, 95% CI = 0.55-0.88) and 23% less likely to receive annual dental check-ups (OR= 0.77, 95% CI = 0.61-0.97). Women with psychologic distress were 27% less likely to receive a clinical breast examination (OR = 0.73, 95% CI = 0.57-0.94). Psychologic distress was not significantly associated with screening for hypertension, colon cancer, high cholesterol, or prostrate cancer, mammography, or routine check-ups.

CONCLUSIONS

Elderly reporting psychologic distress were less likely to adhere to some, but not all, recommended preventive care guidelines. These results suggest that adherence to recommended preventive care guidelines may be improved, indirectly, by improving recognition and treatment of emotional health problems in the elderly.

The collaborative assessment and management of suicidality versus treatment as usual: a retrospective study with suicidal outpatients

The Collaborative Assessment and Management of Suicidality (CAMS) is a novel clinical approach used to identify, assess, and manage suicidal outpatients (Jobes & Drozd, 2004). The results of a retrospective study evaluating the impact of CAMS versus treatment as usual (TAU) on suicidal outpatients are presented. Patients in the CAMS treatment group (n = 25) resolved their suicidality significantly more quickly than TAU patients (n = 30). CAMS was also significantly associated with decreased medical health care utilization in the 6 months after the start of suicide-related mental health treatment. These results provide promising preliminary support for the effectiveness of CAMS and a foundation for prospective research.

Unmet need for the treatment of depression in Atlantic Canada

OBJECTIVE

Most people with depression do not receive treatment, even though effective interventions are available. Population-based data can assist health service planners to improve access to mental health services. This study aimed to examine the determinants of untreated depression in Canada's Atlantic provinces.

METHOD

This study used data from the Canadian Community Health Survey Cycle 1.1. Logistic regression models explored the prevalence of depression and associated patterns of mental health service use among population subgroups.

RESULTS

Of the respondents, 7.3% experienced major depression in the previous year, as measured by the Composite International Diagnostic Interview Short Form. Individuals with the following characteristics were at increased risk for depression: female sex; widowed, separated, or divorced marital status; low income; and 2 or more comorbid medical conditions. Only 40% of respondents with probable depression reported any consultation about their condition with a general practitioner or mental health specialist. Less than one-quarter of Atlantic Canadians with depression reported receiving levels of care consistent with practice guidelines. Vulnerable groups, including older individuals, people with low levels of education, and those living in rural areas, were significantly less likely to receive treatment in either primary or specialty care.

CONCLUSIONS

These findings suggest inequitable access to services and the need to target interventions to at-risk populations by raising awareness among the public and health care providers. Health systems in the Atlantic region must work toward achieving consistent longitudinal care for a larger proportion of individuals suffering from depression by studying the underlying factors for service use among underserved groups.

Some problems with life event lists and health outcomes

Lists of life events are widely used in health outcomes research. As part of a large cohort study of women's health in Australia, age- and gender-specific life events lists were developed and administered to women in different age groups over time. In this article, we provide empirical evidence that recall of life events is subject to telescoping (i.e., remote events are reported to have occurred more recently) and to mood (women with lower mental health scores report more life events, especially perceived rather than factual events). Nevertheless, even after adjustment for confounders, there is a clear association between poorer physical health and more life events. Therefore, these results demonstrate a continuing need for lists of life events in health research but also highlight the methodological challenges in using them.

Relationship of depressive symptoms and mental health functioning to repeat detoxification

To better understand residential detoxification use, we assessed the roles of depressive symptoms (DS) and mental health functioning (MHF) on repeat detoxification. A prospective cohort of residential detoxification patients (N=400) without primary medical care was followed over 2 years at 6-month intervals. Subsequent detoxification admissions were examined using a statewide administrative database and DS (Center for Epidemiologic Studies Depression Scale) and MHF (SF-36 mental component summary subscale) measurements at follow-up. Incidence rate ratios of return to detoxification were estimated using multivariable longitudinal Poisson regression. In separate analyses, greater DS and worse MHF predicted higher detoxification use rates. Clinically significant worsening (10 points) of DS and MHF on objective scales predicted a 20% increased rate of detoxification readmission. Male sex, heroin as a problem substance, and race/ethnicity each predicted detoxification use. These data suggest that identifying individuals with DS or worse MHF after detoxification may provide opportunities for clinical intervention to reduce recurrent residential detoxification.

Common mental disorders and use of general health services: a review of the literature on population-based studies

OBJECTIVE

To review population-based studies on the association between common mental disorders and the use of general (non-mental) health care services.

METHOD

Literature search in Medline and PsychLit databases. Only studies with a prospective design and correction for somatic morbidity were included for review.

RESULTS

On the most general level of outcomes considered and in the majority of studies, mental disorders were associated with higher service use. This general tendency is not consistently reflected in the use of specific health care services, but is materialized in different patterns of out-patient and in-patient service utilization, which vary from study to study. Findings for the elderly were less clear-cut than for other age groups.

CONCLUSION

Mental disorders are related to higher general health care service use on a global, aggregated level. These associations are not specific for certain types of services.